Minimizing The Risk Of Case Management Malpractice

sandra l. lowery

Serving as a case management expert and expert witness for litigation related to case managers facing an allegation of professional malpractice, I have developed an understanding of the importance of legal risk management. Of utmost importance is the need for case managers to comprehend and adhere to various professional standards, including those of their discipline, specialty and certification. Additionally, case managers need to follow applicable state and federal laws that relate to both their discipline and specialty. With the expansion of the Nurse Practice Act in many states, the burden of nursing licensure in multiple states has lessened.

There are several common areas of alleged case manager negligence that have been filed in court. Though not an all-inclusive list, the major ones include delays in advocacy, clients’ lack of self-determination and autonomy, denial decisions, nonadherence to their organization’s policies and procedures, unsafe transitions and the lack of a comprehensive assessment.

To minimize the risk of legal problems, documentation of the case manager’s actions is essential, demonstrating adherence to those standards, policies, and laws that apply to them. Organizations should ensure that their policies and procedures related to case management practice should align with these. This places them in a defensible position should they have to face an allegation of case manager negligence.

From the growth of case management, it is likely that it is going to be subject to greater legal scrutiny. However, it is important to have some perspective. Consider that healthcare professionals are generally not sued by those they feel have been helpful and supportive. And, with the current focus on case managers working on transitions along the care continuum, the risk of avoidable medical complications should decrease.

I am often asked whether a case manager should have professional liability insurance specific related to case management practice. This is a personal decision, and you will find lawyers that opine both ways. “You can’t have too much insurance” versus “You create the image of another deep pocket.” Most organizations who hire case managers have liability insurance that cover them. If one is self-employed, to carry applicable liability insurance is obviously prudent. Fortunately, CMSA has affiliated with an insurer for this type of insurance.

Sandra L. Lowery, RN, BSN, CCMis president of CCMI Associates. She has worked as a case manager, case management consultant and trainer for the past 32 years, working locally and nationally for both payers and providers in the private and public sectors. Sandi was on the CMSA Board for 9 years, was the 2000-2001 president and in 1995 she was received CMSA’s Case Manager of the Year award.


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