Attorney contact policy helps handle large volume

Calls from attorneys looking for information about cases are an unavoidable part of working in health care. Usually, they amount to little more than a small nuisance. But when the calls come in by the hundreds every single day, they can create a huge workload for your staff and increase the chance of information being improperly disclosed or withheld.

That’s when it’s time to develop a facilitywide policy that will ensure the calls are handled properly, suggests Helen Johnson, RN, risk manager at Harborview Medical Center in Seattle. When her facility became overwhelmed with attorney inquiries a few years ago, she worked with colleagues at the University of Washington, which manages the hospital, and the state attorney general’s office to develop a formal "attorney contact policy" that guides employees through the approved process for responding. The 411-bed hospital needed such a policy probably more than most hospitals would because of its size and heavy patient volume, but the need exists on a smaller scale at almost any acute care facility, she says.

Harborview serves as the trauma center for Washington, Alaska, Montana, and Idaho — about a third of the U.S. landmass. It also serves as the county hospital, so it has a huge volume of trauma patients every year in addition to the other patients. Because such a large percentage of those patients were involved in accidents of some type, staff get frequent calls from attorneys requesting records or answers to questions.

"There’s a lot of third-party litigation involving these patients, so we get a number of calls to people all over the hospital," Johnson says. "They call anywhere and everywhere. We have a hard time estimating how many calls we get, but we got 58 requests in just the orthopedic department in one day. That’s typical."

With that volume of inquiries, it was impractical to have all of them referred to risk management, even though Johnson would prefer to handle that type of call herself to ensure it is done correctly. But just leaving staff to handle the calls as they saw fit also was not a good option, mostly because Johnson and her colleagues feared some calls would be handled improperly. Either the busy clinical staff would fail to comply with legitimate requests by attorneys, thereby failing in the hospital’s obligation to turn over documents, or they would accidentally disclose confidential information simply because they didn’t know what could be released.

"In addition to the volume problem, staff would get very nervous about complying," Johnson explains. "We also got a lot of expressions of frustration from attorneys that they didn’t know how to best get information, and sometimes the staff didn’t know how to help them."

A blueprint for response

The solution was a formal policy that instructs staff on how to comply with attorney requests. The result: Staff have much more confidence in how to respond, and the risk managers can worry less about mistakes. The policy also helps streamline the way requests are handled, and that helps staff deal with the high volume of calls.

Johnson and her colleagues started developing the policy in 1995, but they could not find any similar policies on which to base it. So they created a new policy of their own. Johnson says she normally believes all policies should be kept to two pages or less, but this one had to be more extensive because it provides detailed guidance to staff who are not primarily responsible for releasing information and dealing with attorneys. The policy is 10 pages, plus a one-page algorithm that serves as a quick guide. (See p. 138 for an excerpt from the policy and p. 139 for the algorithm.)

"We first decided how to triage the calls and determine what was needed," Johnson says. "We wanted to provide an efficient response but not place an undue burden on the staff."

A large portion of the guidelines are simple and straightforward. They instruct staff to refer to the risk management department any calls that might involve litigation against the hospital, staff, or physicians. Other calls should be directed to the department that can help the attorney most directly. Many callers need medical records, so the policy states that those callers should be directed to the medical records department and provides the phone number.

Other callers want to know how to file a malpractice claim, identify a signature on a medical record, obtain a hospital policy, get information on psychiatric treatment, identify guardians, or learn about the University of Washington’s business involvement. The policy outlines the correct departments that can help callers with those questions, and it provides other guidance on what kind of information staff may and may not release.

For instance, it is common for attorneys to call for help in identifying a signature on a medical record. They will call just about anywhere and ask whoever answers the phone for help, Johnson says. They usually don’t get a good answer and keep calling all over the hospital. Under the new policy, the first employee to take the call directs the attorney to the medical records department for initial review and then to the treating unit’s department manager for further help.

Help staff make good decisions

Other portions of the policy go beyond just handling the initial phone call from an attorney, dealing with more involved attorney contact such as depositions and trial testimony. Because attorneys often take a scattershot approach to getting witnesses, the policy explains the difference between a fact witness and an expert witness. If an attorney calls and asks staff to testify as fact witnesses, they’re obligated to do so. But if the attorney wants them to testify as expert witnesses, they are not obligated to comply. The high volume of such calls often left clinical staff feeling they were constantly being asked to participate in litigation, and the distinction sometimes was not clear to them.

"You have a duty to testify to the facts that you documented in the chart, but if they want expert testimony, that’s an option you can decline," Johnson says. "We have requests sometimes where the attorney wants to speak with 25 members of our staff, and it’s difficult to meet those requests and carry on business. We try to get them to pinpoint who they really need to talk to."

The policy required a series of discussions among risk managers, an assistant attorney general for the state of Washington, and others. Harborview’s emergency department and burn units fielded a large number of calls from attorneys, so Johnson included managers from those departments in the discussions. (See box, p. 137, for the assistant attorney general’s advice.)

Once the policy was finalized in 1995, it was adopted by Harborview and the University of Washington. Johnson calls the policy a tremendous improvement in the way attorney contacts are handled, and she suggests a similar one could be useful in most health care facilities in which patient volume is so high — or the risk manager so busy — that not all of them can be routed through risk management. "This policy has decreased phone calls to my office by about 20%," she says. "I still get the calls for matters that need my attention, but the policy has reduced the number of calls my office gets from staff who just want to know how to handle a request. I also don’t hear complaints from attorneys they way I used to."