Using the sample professional liability insurance policy (Chapter 11 p. 191-192 Figure 11-1) locate the various provisions:
Assignment Description:
For this week assignment, write a 1500-word essay addressing each of the following points/questions.
Read the case study presented at the end of Chapter 10, which begins “The elderly patient resided at the nursing home for almost a year before she died at the hospital.”
- Did the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case?
- Was there negligence on the part of the nursing staff in the care of this patient?
- What could the nurse have done differently to facilitate a different outcome in this case?
- How would you decide this case?
Using the sample professional liability insurance policy (Chapter 11 p. 191-192 Figure 11-1) locate the various provisions:
- Limits of liability
- Declarations
- Deductibles
- Exclusions
- Reservation of rights
- Covered injuries
- Defense costs
- Coverage conditions and supplementary payments
- Did you have difficulty finding some of the sections? Would this be a policy that you would consider purchasing for your own liability coverage? Why or why not?
Read the case study presented at the end of Chapter 11, You Be the Judge, which begins, “During an unexpected heat wave,…” (Guido, p. 195):
- What provisions of an insurance policy would you consult to determine if an insurance company should pay such a claim, and what would the limits of the liability be?
- Is the nursing home insurance company correct in saying that this is a professional judgment issue?
- Which insurance company (the nursing home’s or that of the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment?
- How would you decide the case?
Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.
Submit only the assignments corresponding to the module in this section.
Verified Answer
Nursing Documentation and Professional Liability Insurance
Nursing documentation is the record of a nurse’s observations, assessments, interventions, and evaluations of a patient’s health status. This documentation is an important tool for communication among healthcare professionals and a legal record of the care provided. This paper will focus on the analyses of the impact of documentation and lack thereof in the healthcare sector. Additionally, the paper will address the issue of professional liability insurance policies and how they are applied in fields and instances.
Case One: Chapter Ten
Did the lack of documentation in the admitting nurse’s assessment and notes affect the ultimate outcome of this case?
As a physician, I believe that the lack of documentation pertaining to the overall grade III necrotic pressure ulcer on the coccyx for the patient as well as any other specialized treatment may have played a role in the patient’s ultimate outcome. From one perspective, it could be considered a case of delayed diagnosis due to the failure of the nurse to identify the symptoms (Guido, 2020).
Furthermore, the competency of the nursing staff at home is questionable. It is likely that their insufficient expertise contributed to the failure to identify the issue at the assessment level the need for better bedding. The main concern is whether the nursing home has any established protocols for the care of bedridden patients and if they provide appropriate bedding for treatment and prevention measures. In this instance, the risk for developing pressure ulcers ought to have been noticed at an earlier stage, highlighting the importance of utilizing specialized mattresses.
However, it could also be argued that if a diagnosis had been made and documentation had been properly kept, it could have directly impacted the patient’s final outcome. Early administration of the correct treatment by other members of the healthcare team could have potentially altered the patient’s outcome.
Was there negligence on the part of the nursing staff in the care of this patient?
The patient’s death can be attributed to the neglect of the nursing staff, which constitutes a violating the standards of nursing. The failure to properly observe the progress of the patient within the nursing facility is a clear indication of negligence. Care providers are trained and expected to assist their assigned patients through constant and effective evaluating them and consistently recording any changes in their condition (Griffith, 2020). The patient’s outcome was negatively affected due to the nursing team’s failure to assess and diagnose pressure ulcers properly.
The inadequate quality of treatment and documentation further supports the conclusion of negligence. There is no evidence of supported ambulation or the use of specialized mattresses in the patient’s medical records, indicating a lack of adherence to established standards of care. I believe that the nursing staff who provided care for this patient neglected their duties by failing to properly document procedures, thereby committing negligence.
What could the nurse have done differently to facilitate a different outcome in this case?
The outcome for this patient could have been different if the nurse had paid more attention to the risk factors for pressure ulcers among all patients in the institution. Patients in intensive care who are unable to move or walk are at a higher risk of developing pressure ulcers (Konetzka et al., 2018). Had the nurse discovered the susceptibility of the patient to pressure ulcers, she could have recommended different interventions, such as the use of particular mattresses to prevent their development.
Essentially, the nurse should have conducted a thorough examination of the patient upon admission and during their stay to identify pressure ulcer risks or even to identify pressure ulcers that had already developed. By taking such action in a timely manner, the nurse identified the key issues leading to proper documentation and communication with the relevant personnel. The immune system of the patient was already weakened, making it more likely that other conditions would have developed if the pressure ulcer had been treated sooner.
How would you decide this case?
Based on the case study, the case can be concluded that the care facility’s services were negligent. My decision on the case is based on the failure to properly examine the patient to detect the presence of a pressure ulcer and the potential for such an injury to occur over an extended period (Griffith, 2020). Additionally, the lack of documentation suggesting the patient had been using pressure-relieving mattresses to prevent and treat pressure ulcers, and the absence of established protocols for caring for older, bedridden patients would further support this claim.
Part Two:
Limits of liability
Based on the provided provisions of professional liability insurance policy, some of the categories can be identified from the case. However, there are others that are not easily identifiable. Be that as it may, several of the components can be identified with ease and their examples easily perceived. Based on the case, the individual professional liability is restricted to $3,000,000 in aggregate or $1,000,000 per claim. The following categories were identifiable from the case.
Declaration
The policyholder’s name is stated in the declarations as Judy Doe, who was a registered nurse working in an acute care hospital, community health center between 2018 and 2019. As per the contract, the insured party committed to informing the insurer about the details of every beneficiary that would be compensated in case of anything. Additionally, she agreed to work with an insurance claim agent and offered her complete cooperation.
Deductibles
The insurance policy doesn’t specify the amount the policyholder needs to pay out of pocket in the event of a claim, but it does state that the insurer will reimburse any reasonable expenses incurred by the insured if requested by the company. The policy also has certain exclusions, such as any hospital, sanitarium, clinic, laboratory, or company that is not listed in the declarations, and it does not cover the duties of the insurer as a nurse anesthetist or nurse-midwife.
However, there is an exception to this when the insured serves as a member of a partnership that is formally accredited or on a board or committee of a hospital or professional organization, as mentioned in the declarations (Brous, 2017). Injuries as a result of the insured or anyone for whom the insured is legally responsible during the policy period are covered under the policy.
Defense Costs
Based on the case, in the event a claim is made against an insured business, the insurance company will be required to cover all expenses incurred, any interest on the final judgment amount, and any legal or operational fees charged to the insured (Brous, 2017)
Coverage Conditions and Supplementary Payments
The terms of coverage outline the responsibilities of the insured based on an incident, claim, or legal action, and the insured must inform the company in writing. The insured is expected to promptly provide any legal documents, such as requests, notices, or summonses if they are sued. The company will also cover all legal fees and expenses incurred in the company’s defense and any reasonable expenses incurred by the company in investigating or defending the case.
Challenges and Personal Beliefs
The disorganization made it hard to locate certain sections, leading to multiple issues for me. I would not consider obtaining this coverage for my personal or professional liability because it is difficult to comprehend and has several gaps.
Case 3: Insurance Policy
Provisions to Consult
Based on the case, different areas of concern can be consulted in determining the insurance policy. Some of the policies include declarations, deductibles, covered injuries, rights reserves, supplementary payments, and coverage requirements (Lee et al., 2019).
Professional Judgment Issue
The assertions of the insurance company representing the nursing home that the problem in the case study is a result of the administrator’s professional judgment is correct. The administrator’s decision not to turn on the air conditioner, which ultimately led to the deaths of four residents, was based on their knowledge and expertise and is therefore considered an issue of professional judgment. Rather than being sued by the insurer representing the nursing home, the professional liability insurance of the administrator ought to cover any claims that might arise.
Insurance Companies to Pay the Court-Ordered Judgment
The nursing home insurance company is justified in stating that the decision was professional. The decision comes from the event leading to the deaths of nursing home residents (Paté, 2016). If the administrator has professional liability insurance, the insurance company must pay for any court-ordered judgment.
Deciding on the Case
The case focuses on the circumstances leading to the deaths of the patients within the nursing home. Based on the understanding of the case, the administrator made a professional choice which led to unforeseen negative outcomes. As a result, the professional liability insurance that the administrator is subscribed ought to be responsible for paying any fines or restitutions ordered by the court.
Conclusion
This paper focused on analyzing the impact of documentation and lack thereof in the healthcare sector. Professional liability insurance, also known as malpractice insurance, is designed to protect nurses and other healthcare professionals from financial loss if they are sued for alleged negligence or malpractice. Nurses need to understand the significance of accurate and complete documentation in a legal dispute, as it can be used as evidence in a court of law to defend against any claims of negligence.
References
Brous, E. (2017). Professional liability insurance: What all nurses should know. Journal of Radiology Nursing, 36(4), 236-237. https://doi.org/10.1016/j.jradnu.2017.10.006
Griffith, R. (2020). The elements of negligence liability in nursing. British Journal of Nursing, 29(3), 176-177. https://doi.org/10.12968/bjon.2020.29.3.17
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Prentice Hall. ISBN: 9780134701233.
Konetzka, R. T., Sharma, H., & Park, J. (2018). Malpractice Environment vs. Direct Litigation: What Drives Nursing Home Exit?. The Journal of Health Care Organization, Provision, and Financing, 55, 0046958018787995. https://doi.org/10.1177%2F0046958018787995
Lee, M. J., Lee, M. Y., & Min, H. W. (2019). Nurses’ Perception of Nursing Malpractice Liability Insurance. Indian Journal of Public Health Research & Development, 10(11), 4481-4486.
Paté, J. M. (2016). Professional Liability Insurance: Fact or Fiction?. AAACN Viewpoint, 38(5),1.
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