Q. Consent forms are often signed in the office prior to admission for surgery. How long is the form to be considered valid?
A. At WVU Health Sciences Center, a surgical consent form is valid for up to 30 days unless the surgeon has evidence that the patient has revoked consent.
Q. Is it acceptable to obtain consent over the telephone by a parent, legal guardian, or surrogate when they are unable to come to the Health Sciences Center?
A. Yes, but consent should only be obtained in this manner in emergency situations or when it is determined by a physician that the delay in treating the patient while waiting for the arrival of the parent, legal guardian, or surrogate, would cause greater harm to the patient. The physician should disclose the same information as under normal circumstances. The substance of the telephone conversation and the name and telephone number of the person giving the consent must be documented in the medical record. Also, the telephone conversation should be witnessed by another professional staff member who should countersign the note in the medical record.
Q. Are faxed consent forms valid?
A. Usually the health care facility is required to maintain original evidence of consent in its record. Faxed consent forms may be considered acceptable in unusual circumstances, but must be followed by the original form (brought from the office) immediately.
Q. My patient has been premedicated but has not signed the consent form. May surgery proceed?
A. It is much preferable to obtain documentation of the consent prior to premedication. However, presuming that the physician has discussed the surgery with the patient prior to premedication, documentation by the responsible physician of that discussion in the medical record may be acceptable under Health Sciences Center policy. If the patient signs a form after premedication, the physician must document that fact and that the patient was awake, alert, and aware of the circumstances.
Q. My patient did not sign a consent form prior to surgery. Now that the surgery has taken place, should I get the form signed?
A. No. That should never be done. Either no consent was necessary (because the surgery was an emergency), or consent was documented by the surgeon prior to surgery in a progress note. “Retrospective” consent is ineffective.
Q. May a patient revoke his or her consent for a procedure or treatment once it is given?
A. Yes. A patient has the right to revoke his or her consent either verbally or in writing at any time. When this situation occurs, the patient’s physician should be notified immediately. A patient has the right to revoke his or her consent during a procedure or treatment. If this occurs, the procedure or treatment should be terminated at the earliest (and safest) time possible. The patient’s revocation of consent must be documented in the medical record.
Q. Who provides medical malpractice coverage for health care providers at the Health Sciences Center?
A. All health care providers employed by or enrolled at West Virginia University have medical malpractice coverage through the West Virginia Board of Risk and Insurance Management.
Q. How can I get proof of my liability insurance or a claims history?
A. With your written authorization, the Risk Management office will send a letter describing and verifying your coverage and a claims history to medical licensing boards, facilities and insurance companies. See the authorization form on the web site.
Q. What are my dates of coverage for medical malpractice at WVU?
A. Your dates of coverage are the dates of enrollment or employment at WVU.
Q. How much coverage is provided?
A. One million dollars per occurrence on an occurrence basis.
Q. Do I need tail coverage when I leave?
A. No, you are covered for all incidents that occur within the duties and responsibilities of your role at West Virginia University.
Q. Is an apology after an adverse event an admission of negligence?
A. No. In fact, an apology after an adverse outcome can often influence a litigious patient not to pursue a malpractice claim. The nature of the apology, however, should be about the patient’s current position, not about fault or negligence.
Q. I got a Notice of Claim in the mail. What should I do with it?
A. Send it to Risk Management immediately so the insurance carrier can be put on notice and the records can be collected for your review.
Q. I got a subpoena. Do I have to appear?
A. Yes, if it is a valid WV subpoena and you received adequate notice. The Risk Management office can help determine if you need to appear.
Q. How can I find out if I have a claim in the National Practitioner Data Bank (NPDB)?
A. By either contacting the hospital medical staff office, the state licensing agency, or by calling the NPDB directly at 1-800-767-6732.
Q. How can I protect myself from a lawsuit when a patient is noncompliant and does not follow up as recommended?
A. The standard to meet here is to make a “reasonable effort” to contact the patient and remind them to follow up. The reasonable effort may vary with the importance of the follow-up. For example, a patient who continually misses appointments which are to follow up on an abnormal mammogram (suspicious for malignancy) may need a registered letter sent to her house, while a less critical issue could be dealt with by sending a regular letter via U.S. mail.
Q. What is the best way to terminate a relationship with a patient who is difficult, noncompliant, or incompatible?
A. Discuss your decision and the reasons for your decision to terminate the relationship with the patient. Document the discussion and the reasons in the medical record. Then send a certified letter to the patient citing your decision and the reasons. Also in the letter include: an offer to continue treatment for thirty (30) days until the patient finds another physician, and include a specific date when you will consider the relationship terminated; an offer to assist the patient in finding a new physician (perhaps send the patient a list of physicians); and, finally, include an offer to provide the patient’s new physician with a copy of the patient’s medical record. Also, see UHA Ambulatory Services Policy & Procedure Manual, Policy No. V.210.
Q. An attorney called me and wants to talk about one of my patients. Should I talk to them?
A. Before talking to anyone about your patient, there must be a valid, written, HIPAA-compliant authorization from the patient. If you have the patient’s permission to speak to an attorney, then you can decide whether or not you want to talk to that attorney.
Q. What should I do if an attorney wants to take my deposition?
A. First, you must either have the patient’s authorization or a subpoena before you can give a deposition. If you want assistance in the deposition process, you can contact HSC Legal Services for help. Special rules apply for Behavioral Medicine/Psychiatry so please contact Risk Management or Legal services before proceeding.