Don’t get caught in the us-vs.-them’ scenario

Protect yourself when difficult situations arise

  • You have a workers’ compensation patient who insists on having his attorney present at every meeting.
  • A patient refuses to comply with his treatment and yells at you each time you see him.
  • The outcome of a surgical procedure chosen by one of your clients isn’t what he had hoped for.

These are three situations where case managers need to take proactive steps to protect themselves from liability.

"There is an us-vs.-them’ scenario that occurs in health care, and the case manager sometimes is caught in between, trying to make sure the patient gets appropriate care," says Susan Gilpin, JD, chief executive officer of the Commission for Case Management Certification in Rolling Meadows, IL.

When you encounter difficult situations, it’s helpful to follow up with a letter that documents your intervention with the client.

Use your word processing software to created standard form letters you can customize for each client and for each incident.

In the case of difficult or noncompliant individuals, document every phone call and encounter you have with that client. In addition to case notes, send letters repeating the discussion you had and the actions you agreed upon.

"With noncompliant patients, there is always the risk of a bad outcome. They aren’t taking anyone’s advice because of their own stubbornness. But if they die, family members look around for someone to blame, even if they understand that the patient wasn’t doing what they were told," Gilpin says.

The same scenario can apply to case managers who are involved in disease management programs and encounter noncompliant patients.

"There will be instances involving people who do not want to take responsibility for their own errors. It’s easier to blame someone else for their own weaknesses," Gilpin adds.

In workers compensation cases, there often is already a stressful and adversarial situation by the time the case manager gets involved.

"In workers’ compensation, the injured person may have an attorney and is already thinking about additional lawsuits. It’s not just a benign situation where you try to get them back to work. It’s fraught with emotion, and the potential for legal action against the case manager is never far away," Gilpin adds.

In these cases, make sure you send a copy of your documentation to the attorney. For instance, document that you set up an appointment for an independent medical examination and send a copy to the attorney.

If the patient misses a physical therapy appointment or has any other noncompliance issue, send him or her a letter and send a copy to the attorney.

When you encounter a situation in which an individual has different treatment options, make sure they know the pros and cons of all the options.

"While the case manager may explain early on that there could be a bad outcome, if it happens, remind them of the discussion about the pros and cons of the treatment," Gilpin advises.