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Special Report: Katrina Deaths
Policy can't cover all situations, can backfire
The president of the American Society for Health-care Risk Management (ASHRM), Peggy B. Martin, ARM, MEd, CPHRM, DFASHRM, senior risk management coordinator at Lifespan Risk Services in Providence, RI, notes how the Tenet Healthcare Corp., the parent company of Memorial Medical Center, seems to be distancing itself from the accused clinicians.
Martin says that is not what she would recommend to her corporate executives in the same situation, at least not until there is more information about what happened or criminal charges are filed.
No matter how scandalous the allegations, Martin says risk managers usually should stand behind their clinicians until there is sufficient evidence to think they have committed an egregious act. Based on the information released so far, she is not yet convinced that Pou and the nurses accused in this incident committed a crime.
"Unless I had reason to think they were totally inappropriate — and that would take a lot of investigation — I would stand by them. No way I would abandon them just because the headlines are so salacious," Martin says. "But I would make sure my institution understood what happened, as far as we know, and I would make sure we had good criminal attorneys consulting us."
Use a general policy
Martin does caution risk managers that it is not realistic to try developing a policy or procedure that would apply in such dire circumstances. A key point is that the situation at Memorial Medical Center was so bad that the clinicians had to do whatever they thought best for the patient, she says, and they could not be expected to follow any specific procedures.
"I would rather have a general policy that says we count on the provider's clinical judgment in every circumstance to do what is best for the patient," she says. "After you've credentialed them properly and make sure you have the best people, we have to count on them to do whatever is best in any circumstance."
Any attempt at a policy that defines what can and can't be done in a crisis situation can backfire, Martin warns. "We get in trouble if we try to make a too restrictive policy because it doesn't allow for clinical judgment," she says. "We're hanging ourselves with a policy that may not apply in every circumstance. Sometimes we have an incident and then have a knee-jerk reaction to make our policies stricter and more prescriptive, even though we know the clinicians can't follow them."