Home | Organization | Services | Member Benefits
Legislative | Socieconomics | Calendar | Contact & Proposals

News

Have a proposal for FOGS or looking for a service?
Use this link to contact our office.
More...

Thank You!
FOGS and the Florida Section ACOG recognize their corporate supporters
More...

Liability Issues Report
Please use this form liberally to report the related practice problems you are facing
The Form

Login

On Call Medical Coats
FOGS has teamed up with On Call Medical Coats to offer our members quality embroidered labcoats
Shop for Coats

FPIC FOGS Endorsed Malpractice Carrier offering a 5% discount to FOGS members
More Info


Lubell & Rosen
FOGS Endorsed
Pre-Paid Legal Defense
More Info

CompOptions Your practice could receive a dividend of up to 24.8% of your workers compensation premium.
More Info

      

NICA - It Can Help

Arthur Clements, MD, PhD and NICA board member

When Treasurer Tom Gallagher invited me to serve on the Board of the Florida Birth Related Neurological Injury Compensation Association (NICA), I was honored but not quite certain what to expect. In the first few months I accepted the appointment, I began to realize that one of my primary commitments would be continuing to improve communications between the practicing OB/GYN’s of Florida and the NICA board. This program was created to benefit the families of neurologically injured infants as well as to ease the insurance burden of the working physician.

In an effort to achieve the goal of improved communication between the physician and the NICA administration the following changes have occurred. The Executive Director has been given direction by the Board to work on relationships with all of the associations and groups who support and are the constituents of this program. A website has been established at www.nica.com, and there have been efforts to provide educational programs and support services for the hospitals, doctors and families. There is a new logo that is more representative of a service organization instead of a state taxing authority, and the culture has changed to be more open and involved in problem solving rather than defensive posturing.

On that note, I would like to urge all FOGS members to take advantage of NICA services, and I want to especially urge those members who participate in NICA to be aware of what to do when you have a NICA claim.

In the last year, NICA has joined in litigation involving participating doctors and hospitals to force the lawyers to abate lawsuits filed in circuit courts and bring their claims to NICA. A lot of the claims are now being accepted for compensation; however, in too many instances NICA has been unable to keep the claim because there was no sufficient proof that the patient had been given the brochure before delivery, which is required as notice of NICA participation. For example, 4 of 10 recent cases that were accepted by NICA were allowed to proceed in circuit court because the hospital or doctor had not established NICA procedures and sufficient documentation to prove they had handed out the NICA brochure.

I hope none of you ever have a situation that gives rise to a claim, and I hope you never have to use the procedures you set up. However, if a bad outcome results in a claim against you, I also want to be sure you get the coverage we are all paying for. Ways to correct consent failures:

  • Establish office procedures in writing clearly outlining when the brochure is to be given and by whom. The best time is at the first contact or intake appointment, but it must be before delivery. Place this in your office employee and procedure manual.
  • Make sure that it is a routine procedure and followed with every patient. • Document in the patient record the date and times the notice is given, and have the person giving the notice sign or initial.
  • Use an acknowledgement form that is signed by the patient and dated, and have the staff member sign the form as well as the patient’s records.
  • Three months prior to delivery, or at some established time frame before the delivery, do a routine audit of the patient charts to be sure the documentation is there. If it is not there, send it to the patient by certified mail and retain the receipt. Make sure this is done prior to sending prenatal records to your L&D.
  • If when on call you accept "transfer patients, out of group patients or drop in (no prenatal care) patients," "place on your standing order admit sheet, have patient review and date NICA forms documenting that they received the brochure given by you and the hospital prior to delivery."

And if you have a claim:

  • When we get involved in a case with a catastrophic outcome we tend to seek refuge from our comrades; they bathe us with kindness and understanding. This helps for short term but we need to be aggressive and realistic in what is going to happen, so that we are prepared for the inevitable lawsuit. Get your hospital risk manager involved right away; many cases can be resolved prior to the patient’s discharge. We have actually settled cases prior to patients leaving the hospital!
  • Think of the NICA criteria:
    • Singleton 2500 grams
    • Multiple gestation 2000 grams
    • Labor delivery or immediate resuscitation period (patient must be in labor, i.e. patient comes in with a placenta previa hemorrhaging, is taken to the OR for section and active labor was not documented). This will result in a voided claim.
    • Permanently and substantially mentally and physically impaired.
  • Make sure that the events surrounding the labor and delivery are clearly documented in the chart. Document labor! Document live birth or resuscitation that restored a fetal heart beat even if atonal. Stillbirths are not covered. Make sure cord ph and blood gases were ordered.
  • Review all nurse’s notes for accuracy and have them correct deficiencies with proper documentation.
  • Get a copy of the fetal heart tracing and keep it in a safe place. This record is one of the most critical records you will ever need.
  • Keep all medical records in one place so that they are readily accessible when the requests for records come in. Make an extra copy for easy access.
  • Identify who gave the office and hospital notice and get an affidavit from them if possible. Keep it in a safe place.
  • Call NICA and advise of possible claim (850) 488-8191 immediately! We can perform a quick review to check on the likeness that the case will be covered.

In summary, think labor, FHT’s, resuscitation, cord gases and documentation!

Remember that all proof must meet an evidentiary standard. Protect your patients, your staff and yourself by assuring that NICA will be able to keep the cases that should be in the program.

If you have any questions about a potential claim, or need guidance on how to get or keep a potential case in NICA, contact us. The resources are there for our members, let’s put them to good use.

If you have any questions about NICA, call us at 1-800-398-2129 or visit the website at www.nica.org.