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Physical Therapy Liability 2001

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Physical Therapy Liability 2001 2001-2010Physical Therapy Liability We firmly believe that knowledge is the key to patient safety. Contents PART ONE: CNA HealthPro Physical Therapy Closed Claims Analysis . 5 Introduction . 7 Purpose . 7 Database and Methodology . 7 Scope . 8 Terms . 8 General Data Analysis . 9 Analysis of Closed Claims by Insurance Source . 9 Severity of Physical Therapist Closed Claims by Year Closed . 10 Distribution of Closed Claims by Severity . 11 Analysis of Severity by Location . 12 Analysis of Severity by Allegation . 13 Allegations by Category . 13 Allegations Related to Improper Management over the Course of Treatment . 14 Allegations Related to Failure to Monitor or Supervise. 15 Physical Therapy Closed Claim Scenario: Failure to Properly Monitor or Supervise . 15 Allegations Related to Improper Performance Using Therapeutic Exercise . 16 Physical Therapy Closed Claim Scenario: Improper Performance Using Therapeutic Exercise . 17 Allegations Related to Improper Performance of Manual Therapy. 17 Allegations Related to Inappropriate Behavior by Physical Therapist . 18 Allegations Related to Equipment . 19 Allegations Related to Improper Use of a Physical Agent . 19 Physical Therapy Closed Claim Scenario: Improper Use of a Physical Agent . 20 Analysis of Severity by Injury . 20 Comparison of Re-injury Versus Other Injuries . 22 Analysis of Severity by Re-injury . 23 Analysis of Re-injury by Affected Body Part. 23 Allegations Related to Re-injury . 24 Analysis of Claims Related to Burns . 26 Analysis of Severity Related to Burns by Body Part . 26 Analysis of Severity by Disability . 27 Summary Analysis of Physical Therapist Assistant Closed Claims . 28 Severity by Allegation . 28 PTA and PT Closed Claims: Comparison of Top Three Elements by Severity . 29 Physical Therapy Closed Claim Scenario: Alleged Improper Care (a Success Story) . 30 Risk Control Recommendations . 31 Risk Control Self-assessment Checklist for Physical Therapists . 36 Your Role and Responsibilities in Managing a Professional Liability Claim . 40 PART TWO: Healthcare Providers Service Organization Analysis of Physical Therapy License Protection Paid Claims January 1, 2001–December 31, 2010 . 41 Introduction . 43 Scope . 43 Database and Methodology . 43 License Protection Paid Claims . 43 Claims by Insurance Coverage Type. 43 Claims by Licensure Type. 44 Claims by Location . 44 Allegations by Class . 45 Allegations Related to Improper Management over the Course of Treatment . 46 Allegations Related to Inappropriate Behavior . 47 Allegations Related to Fraudulent Billing . 48 Licensing Board Outcomes . 49 Recommendations . 50 PART THREE: Highlights from Healthcare Providers Service Organization 2011 Qualitative Physical Therapist Work Profile Survey . 51 Introduction . 53 Survey Background and Methodology . 53 Summary of Findings . 55 Topic 1: Respondent Demographics . 56 Physical Therapy Licensure . 56 Gender. 56 Age. 56 Highest Level of Education . 57 Topic 2: Practice Profile . 58 Location of Practice . 58 Primary Language. 58 Annual Continuing Education (CE) Requirements. 59 Topic 3: About the Claim Submitted . 60 Seeking PT Without a Referral . 60 Years of Practice at Time of Incident . 60 Patient Care Assistance . 61 Certified in Practicing Specialty . 62 Policy on Disclosure of Mistakes . 62 Effect of Inadequate Staffing. 63 Number of Patient Visits Scheduled per Single Appointment Session Time. 64 Supervision of Others. 65 Topic 4: Facility Profile When Claim Was Submitted . 66 Type of Medical Records . 66 Risk Management Plan. 66 PART ONE CNA HealthPro Physical Therapy Closed Claims Analysis PART ONE: Introduction Through Healthcare Providers Service Organization (HPSO), CNA continues to be the nation’s largest underwriter of professional liability insurance coverage for physical therapy professionals, with over 70,000 policies in force in 2011. In collaboration with our business partners at HPSO, we at CNA are dedicated to educating physical therapy professionals regarding professional liability risk exposures relevant to their practice. Part One of this report focuses on risks faced by physical therapists (PTs), whether they are insured as individuals or as employees of physical therapy practices. A subsection of Part One addresses the specific professional liability risk exposures for physical therapist assistants (PTAs) insured by HPSO/ CNA and other healthcare professionals providing services on behalf of a HPSO/CNA-insured physical therapy practice. Purpose We firmly believe that knowledge is the key to enhancing patient safety and managing risk. Our goal is to help PTs enhance the quality of their patient care services by providing fact-based risk management information and guidance. The risk management information presented in this report is based upon an analysis of closed professional liability claims that resulted in sizable settlements or adverse judgments. Part One focuses on closed claims in order to identify the types of incidents most likely to have resulted in significant consequences for patients, therapists and practices. By offering data analysis, risk control recommendations and a self-assessment checklist, we strive to encourage our insureds to examine their own clinical practice and policies, discern areas of possible improvement, and dedicate themselves to maximizing patient safety and minimizing risk. We believe that physical therapy professionals in every type of practice setting will find this report a valuable educational resource. Database and Methodology There were 3,889 professional liability closed claims and incidents attributed to CNA-insured physical therapy professionals in the HPSO program from 2001 through 2010. Professional liability claims were included in the final data set only if they - involved a licensed PT or PTA whether insured independently or through a PT practice or other healthcare professional providing services on behalf of a PT practice - resulted in a closure date between January 1, 2001 and December 31, 2010 - resulted in an indemnity payment equal to or greater than $10,000 Closed claims with an indemnity payment of less than $10,000 were excluded for the reason that they typically reflect injuries that were less severe and/or resolved without extensive litigation. These criteria generated a data set of 552 closed claims. There were 477 closed claims asserted against PTs, 49 closed claims asserted against PTAs and 26 closed claims asserted against other healthcare pro- fessionals providing services on behalf of an insured PT practice. Findings for closed claims asserted against PTs or PTAs insured as individuals or by a PT practice, and against other healthcare professionals insured by a PT practice, are summarized in Figure 1 and Figure 2 (page 9). Findings for all closed claims meeting the criteria noted above and asserted against PTAs are summarized in Figure 23 and Figure 24 (pages 28 and 29). The methodology used in this report differs from the 2007 CNA Physical Therapy Claims Study and PT claims studies developed by other organizations. For that reason, it is not advisable for readers to compare findings in this report with those of other studies or reports. CNA HealthPro andPART HPSO Physical Therapy Liability,ONE 2001–2010 7 Scope Claim characteristics analyzed within the report include incident location, allegation, injury, re-injury and related disability. Also included is a summary review of closed claims comparing individually insured PTs with PTs providing services as employees of insured PT practices. Noted indemnity payments or expenses were paid by CNA on behalf of an insured and do not represent any additional amounts paid by employers, other insurers or other parties in the form of direct or insur- ance payments. This analysis reflects CNA data only and is not necessarily representative of all closed claims for PTs, PTAs and/or PT practices. The process of resolving a professional liability claim may take several years. Therefore, claims included in this report may have resulted from events that occurred prior to 2001, as long as the claim closed between January 1, 2001 and December 31, 2010. Terms For purposes of this report, please refer to the definitions below: - Allegation – An assertion that the professional or organization has done something wrong or illegal, which has not yet been proven. - Expense payment – Monies paid by CNA in the investigation, management or defense of a claim. - Incurred – Costs or financial obligations, including indemnity payments and expense payments, resulting from the management and resolution of a claim. - Indemnity payment – Monies paid by CNA to a plaintiff on behalf of an insured in the settlement or judgment of a claim. - Physical therapy practice (PT practice) – An organization insured through the HPSO/CNA physical therapy program that provides professional physical therapy services and whose employees may include PTs, PTAs, PT aides, massage.
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