The Medical Staff Coordinator has again called upon your expertise in the area of healthcare law. You have been asked to provide a written discussion on professional liability and medical malpractice. You are asked to provide the information outlined below and use research (at least two sources) to substantiate your discussion.

  • Define liability and malpractice.
  • Summarize the three areas of general liability for which a physician/employer is responsible.
  • Discuss the role and purpose of risk management.

Use APA 7 formatting and citation standards. Use at least two (2) scholarly references published within the last 5 years to substantiate your work.

FAQs: Malpractice Influence on Health Care


Question 1: What is written about the history of malpractice litigation?

Answer 1:

Very little has been written about the history of malpractice insurance.

However, according to James Mohr (2000) at the University of Oregon, medical

malpractice litigation appeared in the United States around 1840. It appears

that the reason medical malpractice came about was related to the lack of

quality control toward medical practitioners at that time. Mohr contends there

are several factors contributing to why medical malpractice litigation has

sustained itself, including the pressures for innovation on American medicine
and the spread of uniform standards.

Question 2: Who is required to purchase medical malpractice insurance?

Answer 2: Individual licensed practitioners and licensed health care facilities

are required by law to maintain a minimum level of insurance. States require

practitioners and facilities to obtain insurance for the welfare of patients;

however, rather than settling for the minimum legal standard of the law,

practitioners and facilities should assess and purchase the insurance they truly

need. Medical malpractice insurance purchased by facilities is obtained for the

purpose of covering all those who perform services within the facility (e.g.,
social workers and technicians) in addition to the licensed professionals.

Question 3: Is malpractice insurance provided for a practitioner by the
organization or facility sufficient coverage?

Answer 3: This depends on the individual. All practitioners should consult with

a risk manager to learn their medical malpractice health insurance’s coverage

and limitations. The practitioner should carefully evaluate if the insurance is

sufficient and, if not, purchase additional insurance. If the individual performs

any medical practice not associated with the facility, he or she should have

separate insurance to cover those services because those services will not be
covered under the facility insurance.

Question 4: How is malpractice insurance purchased?

Answer 4: Most often, individual practitioners access insurance through

national associations like the American Medical Association or American

Psychiatric Association. Facilities generally utilize insurance brokers to obtain

insurance. The broker is responsible for representing the facility to the

insurance company. An insurance broker can assemble all the necessary

FAQs: Malpractice Influence on Health Care


information regarding an organization to present to the insurance

Malpractice Influence on Health Care


Activity #1

How well could you train others in the basics of malpractice insurance? Identify

the true statements.

1. Misfeasance is performing an act that is wrong and damaging.

2. Punitive damages are to punish the offender.

3. Medical professional liability is a term preferred by HC providers for medical

malpractice insurance.

4. Res ipsa loquitur is a common knowledge doctrine where no expert witness

is needed in trial.

5. Nonfeasance is when a practitioner is trained in what to do but fails to act at

a time when he/she should.

6. To prove negligence, these must be proven: damages, deliberation, defect,

and duty of care owed.

7. States can also prosecute a healthcare practitioner under criminal law

8. Malfeasance is performing an act, which may be well-intentioned but is
technically illegal.

The true statements are 2, 3, 4, 5, and 7.

Activity #2

Review court cases to ensure you realize what kind of actions can make the

practitioners of your medical facility liable.

A surgeon reads the only records available for an institutionalized patient’s

surgery and sees that he is to operate on a hernia on the right side of the

man’s body. As he looks at the man, he sees a left hernia bulge. He repairs the

right, however, under the record’s directive. The records were incorrect. The

patient sued the state. Was the surgeon liable for anything? If so, what?

Here is the model answer:

In this New York court case, the plaintiff won and the surgeon’s license was

revoked for negligence. The surgeon failed to adequately examine the inmate

and evaluate him medically before the operation. He also relied solely on the
one record instead of obtaining a full medical history

A man receives surgical grafts in his arms for catheterization. After the grafts

were removed, on two occasions in the hospital he bled. The bleeding was

stopped, the patient was observed for several days, then sent home with

instructions on how to apply pressure to the arms if bleeding occurred again.

Malpractice Influence on Health Care


He was also instructed to call the doctor if bleeding reoccurred.

When he returned home, he bled twice. When he applied pressure the bleeding

stopped, so he did not feel it was worth contacting the physician. The next day

his wife left the house to go to the pharmacy, and when she returned 30
minutes later, she found her husband had bled to death.

The wife sued for wrongful death. Whose responsibility was the patient’s death?

Malpractice Insurance


One of the complex business functions that a doctor’s office or health care facility must

perform relates to the avoidance, reduction, or transference of risk associated with

operating a business, and in particular, a medical practice business. This presentation will

provide an overview of insurance in general and discuss some specifics of medical

malpractice insurance.

Overview of Insurance

Insurance is a contractual relationship between two parties, the insured (the individual or

organization who purchases an insurance policy) and insurer (organization issuing the

insurance policy). The basic purpose of insurance is for the insurer to be financially

responsible to a third party in the event the third party seeks to obtain reimbursement for

negligence, fault, or other incident. The contractual relationship is detailed in an insurance

policy outlining the responsibilities of each party. In general, the insurer has obligations of

payment of any claims for the specific type of coverage (such as medical malpractice or

general liability) detailed in the policy. However, it is important to note that policies often

contain language of what they will not cover also, or “conditional coverage” provisions.

The main obligation of the insured is to pay a premium for the insurance policy—usually a

monthly, quarterly, or annual payment. The insured also has the responsibility to ensure

that it adheres to other specific provisions generally related to issues of reducing risk (for

example, operating within one’s scope of practice).

Medical Malpractice Insurance

Medical malpractice insurance, otherwise known as medical professional liability, is a

specific type of insurance that pertains to coverage of risk associated with negligent act(s)

and omission(s) related to the provision or failure to provide proper health care services.

Physicians and other independent medical practitioners who operate a medical practice can

purchase their own professional liability insurance. Facilities often purchase large umbrella

medical malpractice insurance for all medical care workers within the facility. The

individual practitioners or a facilities’ risk manager must assess what types of insurance is

needed and the amount of insurance needed. There are many factors that determine this,

including, but not limited to the following: what the state laws require of licensed

individuals and facilities, insurance requirements of any contracts the individual or facility

may have (e.g., managed care contract), the type of medical care provided, and the amount

of risk (i.e. financial loss) the ind

Negligence and Malpractice



arn the
basic concepts involved with negligence and medical malpractice claims.



would or would not do under given circumstances” (Pozgar, 2004, p. 33).


at he or she is administering to a patient and then administers the wrong

negligence might occur. They include when one does the following (Pozgar, 2004):

uences of an act and does not exercise his or her best

• engages in certain behavior expected to involve unreasonable danger to others

t act

gly innocent one—can cause a patient a
great deal of harm or perhaps even death.


Mr. Smith was just hired to work as a clerk in the risk management department of
County General Hospital. As an employee in this department, Mr. Smith will primarily
deal with any malpractice or negligence claims against hospital employees. It is his job
to gather the necessary paperwork together for the file so that the legal counsel for the
hospital can proceed with the claims being made. Mr. Smith wonders just how many
cases of negligence and malpractice claims he might see working in this position. Wh
exactly constitutes negligence, and what is a malpractice claim? To do his job to the
best of his ability, Mr. Smith decides to do a little research so that he can le

Mr. Smith first researches the concept of negligence. From his reading, he knows th
negligence is a type of tort, which is a civil or a personal wrong committed aga
another person (Pozgar, 2004). In addition, he finds that a negligent act is the
“unintentional commission or omission of an act that a reasonably prudent p

After thinking about this definition, Mr. Smith realizes that negligence is really a form
of carelessness on the part of an individual or group of individuals, which strays
what is considered to be the normal, most accepted way to deal with a situation
(Pozgar, 2004). For example, negligence might occur if a nurse fails to check the
medication th

Researching negligence even further, Mr. Smith notices that there are a few ways tha

• considers the conseq
possible judgment

• fails to guard against a risk that should be appreciated

Using these guidelines, Mr. Smith realizes just how easy it is to commit a negligen
if one is not careful. This is especially crucial in the health care industry because
making any mistake—even a small, seemin

Mr. Smith now has a good idea of the basics of negligence, so he decides to move
forward and look more into malpractice. He discovers malpractice is very similar to
negligence and is sometimes used interchangeably to describe a negligent act. In fact,
malpractice is defined as “the negligence or carelessness of a professional