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A Medical LiabilityInsurance Company
A P P L I E D M E D I C O - L E G A L S O LU T I O N S R I S K R E T E N T I O N G RO U P, I N C .
Insured Colleague
OverviewSince the last edition of Insured Colleague, the financial markets have experienced significant volatility due in part to the uncertainty surrounding Europe and, more specifically, Greece and Italy. There is no doubt we are in a global economy. And AMS RRG, like any other investor, is not immune to the market vagaries. But fortunately, we are
conservatively invested with no direct exposure to the foreign markets. I recently spent time with our investment manager, Brown Brothers Harriman & Co., and am extremely confident that our portfolio is in great hands. As evidence, we need look no further than our year-to-date performance with the corresponding growth in surplus from investments.
As for industry-specific trends, there have been several noteworthy consolidations in recent months:
•TheDoctorsCompanyacquiredFPIC
•NORCALacquiredMedicus
•MedProacquiredPrinceton(partofMLMIC)
As rates continue to stay low, many insurers are using merger and acquisitionstrategiestoimprovepremiumvolume.Additionally,manyinsurers, particularly ones in specific geographic areas, are concerned with the consolidation in the physician market. Hospitals are buying physician practices and placing them in the hospital’s medical liability insurance plan,whichmaybeacaptiveorothertypeproduct.Fortunately, AMS RRG, which is currently registered in 48statesandtheDistrict of Columbia, continues to grow and is not constrained by geographic limitations.
2011 Board Meeting HighlightsIn May, we hosted our annual Board and Shareholder Meetings in Scottsdale, Arizona. Highlights of the events included:
•TheminutesoftheMay6, 2010,andNovember23, 2010, meetingsoftheBoardofDirectorswereacceptedaspresented.
AMS RRG President’s Messageby Richard B. Welch
continued on page six
President’s Message continued from front page
5 6
AMS RRG, INC.
23Route31North
Suite A-10
Pennington,NJ08534
A Medical LiabilityInsurance Company
Richard B. Welch
In This Issue
• Informed Consent pg. 2
AMS RRG has continued to grow since it first insured physicians in May of 2003. One of our primary goals at that time was to help physicians reduce their risk of a lawsuit.
• New 2% Premium Credit Program pg. 4
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offered through Law & Medicine, an ACCME- accredited organization which was founded by Victor Cotton, MD, JD. Dr. Cotton created all of Law & Medicine’s educational materials based on his experiences of having practiced and taught both law and medicine.
• Informed Consent Discounts Through Dialogue Medical pg. 4
AMS RRG members now receive a 30% discount off the standard cost of Dialogue Medical’s informed consent product, which aids with the communication and documentation of all aspects of the shared decision- making process.
• Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements pg. 5
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms.
Fall 2011 | Volume 010 Fall 2011 | Volume 010
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms. Forinstance,alimitedformofindemnity agreement is narrow, shifting the loss to only those negligent acts caused solely by the indemnitor. At the other end of the
spectrum, a broad form of indemnity agreement shifts more loss to the indemnitor, even to the point of responsibility for acts of persons other than the indemnitor.
Consider the following:
An emergency medicine group has a professional services agreement (the“Agreement”)withitshospitalpartner,whichincludesamutual indemnification clause. Specifically, each party indemnifies and holds harmless the other party for its own independent acts of negligence. When an emergency physician misdiagnoses a patient, resulting in a bad outcome, a lawsuit usually names both the physician and the hospital. If the plaintiff makes no allegation of any independent acts of negligence against the hospital, but alleges only that the hospital is vicariously liable1 for the acts/omissions of theemergencyphysician,thehospitalmayrequestthattheEDgroup protect and defend the hospital based on the Agreement. Thehospitalmayarguethat“butfor”theacts/omissionsoftheEDphysician, the hospital would not be named in the lawsuit.
Each state has developed statutory and/or case law regarding vicarious liability and, specifically, vicarious exposure hospitals assume for their medical staff. Hospitals consistently try to push thedefenseofthesecasestothephysician(s)whoallegedlycommitacts/omissions of negligence. Many times, this push by the hospital isextreme.Forinstance,somehospitalswithclearindependentexposureinacase(eitherthroughnursingstafferrors,inadequate
policiesand/orsystemerrors)willnonethelesstrytorequirethephysicians to assume their defense. Most hospital risk managers acknowledge and understand that the hospital will always be consideredthe“deeppocket”byplaintiffattorneys.Bydesign,thehospital has higher professional liability limits. Given this, plaintiff attorneys always try to find some criticisms or independent or direct acts of negligence against the hospital and its employees, even if remote.
Hospitalsfrequentlyaskphysicianstoexecuteindemnityagreements.Unfortunately, professional liability carriers typically exclude this type of contractual indemnity from coverage. Therefore, an obligation to indemnify in the contract between the physician and/or group and the hospital does not pass on to the carrier under a professional liability policy. However, most carriers do cover a limited form of indemnification arising under common law. Given this, physicians must exercise caution when executing broad form indemnity agreements and/or contracts with indemnity clauses.
State statutes and common law dictate the presence of common law indemnity.Toprevailonacommonlawindemnityclaim,1)thepartyseekingindemnity(the“indemnitee”)mustbewithoutfaultand its liability must be solely vicarious for the wrongdoing of another;and2)thepartyagainstwhomindemnityissought(the“indemnitor”)mustbetheoneresponsibleforthetort.Intheseinstances,theindemniteemayrequesttheindemnitortoprotectanddefenditinthelawsuit.Typically,a“tender”letterfromtheindemnitee to the indemnitor indicating its intent to tender its defensesatisfiestherequirementstorequestindemnification.Theprofessional liability carrier may review the letter and, depending on state law and its policy, either accept or reject the tender. If accepted, assigned defense counsel for the indemnitor will protect and defend the indemnitee as well as the indemnitor. This is because, as a general rule, the insurance company wants to protect its insured against any cross action or claims for indemnification that may be filed at a later date.
As to agreements between a physician and hospital, the contractual indemnification language should be limited and mutual:
“Physicianagreestoprotect,defend,holdharmlessandindemnifyHospital for claims of professional negligence alleged against the Hospitalforthesoleacts/omissionsofthePhysician,includingattorneys’ fees as costs. Hospital agrees to protect, defend, hold harmlessandindemnifyPhysicianforclaimsofprofessionalnegligenceallegedagainstthePhysicianforthesoleacts/omissionsoftheHospital,includingattorneys’feesandcosts.”
Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements
bySusanMartin,Esq.,ExecutiveVicePresident,LitigationManagement/LossControl
•TonyHillandClareStensonwithBMS,ourreinsuranceintermediaries, reviewed our current reinsurance structure. They discussed the Corporation’s historical participation in the reinsurance markets, noting that some of the AMS RRG’s reinsurers have been working with us since inception. They alsopresentedafive-yearsummaryofLloyd’sofLondon’sperformance, which is stronger than ever.
•TheMedicalExecutive,UnderwritingandClaimsCommitteesmet over the two-day period. They discussed many ideas regarding continuous improvement to our risk and claims management and underwriting processes. I want to thank all ofourSpecialtyMedicalDirectorsandstaffwhoparticipatedin those meetings.
DividendForthethirdyearinarow,AMSRRGhasbeenauthorizedtoprovideadividend to its shareholders. Although it is a very difficult investment market, continued positive returns that have led to steady surplus growth coupled with ongoing profitability through strong underwriting and claims management have allowed us to issue the dividends.
2012
Asoftheendofthethirdquarter,grosswrittenpremiumwasjustover $26 million, on track toward our goal of $36 million for 2011. We see 2012 as another year of controlled growth while delivering value to our partners/insureds. We will continue to assess and provide the appropriate infrastructure needed to meet and exceed theneedsofourinsureds.Ourgoal,asalways,isunparalleledcustomer service so please let us know how we are doing.
Until next year, I wish you all a very happy and healthy holiday season!
•Saslow,Lufkin&BuggyLLPwereappointedasthe independent auditors of the Corporation for the year ending December31, 2011.
•AonRiskConsultants(GregoryLarcher,FCAS,MAAA)wereappointed as the independent actuary of the Corporation for theyearendingDecember31, 2011.
•TheauditedfinancialstatementspresentedtotheBoardbySaslow,Lufkin&BuggyLLPfortheyearendingDecember31, 2009, were accepted as presented.
•ThecurrentBusinessPlanoftheCorporationwasratified and approved as presented to the board.
•Weheardapresentationfromourinvestmentmanager,BillEnright,SeniorVicePresident,InstitutionalInvestmentManagement, at Brown Brothers Harriman & Co. He reviewed bothourfixedincomeandequitymarketportfolios,bothofwhich were outperforming the indices.continued on page four
Claims Committee meeting at Board Meeting in Arizona
SusanMartin,Esq.
“Hospitals frequently ask physicians to
execute indemnity agreements. Unfortunately,
professional liability carriers typically
exclude this type of contractual indemnity...”
1“Vicariousliability”istheimputationofliabilityupononepersonfortheactionsofanother.
Dr.GaryWortz,whoworkswithiMedConsent(availablethroughtheAMSRRGwebsite)haspublishedsuggestionsforamoreeffective informed consent process:
• Donotexecutetheconsentformonthepatient’sfirstvisitwhile they are still learning about the procedure.
• Donotobtaininformedconsentonthedayoftheprocedure.(Thisiscommonplaceinthehospitalsetting,butjustbecauseithasalwaysbeendonethiswaydoesnotmakeitthebestway.)
• Obtainthepatient’sconsentintheofficesettingwhilethepatientiscomfortableandhastimetoaskquestions.
• Offerthepatientacopyoftheformtheyhavesigned.
• Educateyourpatientsthrough:
–Discussionswiththephysician
–Videosdepictingtheprocedure
– Comprehensive handouts
– A detailed, procedure-specific informed consent form
• Makesurethepatientisanactiveparticipantintheprocess,that they are paying attention and that they confirm their understanding of the procedure, its risks, benefits and alternatives.
• Ifthepatientisunwillingtoacknowledgetherisksyouhavedescribed, delay the procedure until they can demonstrate the appropriate understanding of those risks.
• Ifthepatientrefusestheprocedure,obtainarefusalof consentform,whichmeetsallofthesamerequirementsas the informed consent form.
• Makesurethereisnolanguagebarriertothepatienttrulyunderstanding the procedure. Get an appropriate translator if necessary who will document the informed consent process.
As part of the informed consent process, you will not be able to describe all of the potential risks to any procedure. It is important for patients to understand that there are risks to any procedure that, if they occur, cannot be fixed. Examples would include pulmonary embolism(despiteappropriateprophylaxis)followingakneereplacement, loss of vision following eye surgery, a hoarse voice after thyroid surgery and so on. The list is metaphorically endless.
2
As part of your informed consent process, describe the procedure, the anesthesia associated with it, the key risks, available alternatives as well as various options the patient can choose from with the planned procedure. In addition, a discussion regarding long-term prognosis following the procedure is appropriate as well.
Lastly,itisimportanttodocumentthepatient’spost-procedureresponsibilities. These include, but are not limited to, wound care, medication use and appropriate healthcare follow-up such as lab work(i.e.monitoringtheeffectofCoumadin),attendingrehabsessions, keeping follow-up physician appointments and so on.
While true negligence is still likely to result in a lawsuit, many cases may potentially be avoided involving risks that were well-documented and explained by the healthcare practitioner.
Ifyouhaveanyquestionsregardingyourinformedconsentprocess,pleasedonothesitatetocallStevenShapiro,MD,at800-367-1337.
3
Fall 2011 | Volume 010Insured Colleague
Informed Consent
ByStevenShapiro,MD,AMSRRGChiefMedicalOfficer
planned procedure is most likely one that communicates effectively in all aspects of their interaction with the patient, staff and other allied health personnel.
Many times, physicians believe that informed consent is obtained by nursing when the patient signs the consent form. While these forms oftenincludemanycaveatsregardingthequalityoftheinformedconsent process, these may not hold up in court unless there is documentationbythephysicianregardingthequalityoftheprocess.The patient, or the patient’s family, will simply say they were told to sign the form by the nurse in order to get the procedure, and that theyhadquestionsabouttheprocedurethatthenursingand/ormedicalstaffdidn’thavetimetodiscuss.Patientstrusttheirphysiciansand expect a problem-free outcome; many times, they will not take the informed consent process seriously unless the physician does.
In 2010,theJournaloftheAmericanCollegeofSurgeonspublishedanarticletitled“Predictorsofcomprehensionduringsurgicalinformedconsent,”whichstatedthatthetimespentwiththepatientduringthisprocess is one of the strongest predictors of patient comprehension of the true nature of the procedure including its risks, alternatives and benefits. It is noteworthy that many times you see a physician write down that they had an extensive discussion with the patient regarding various issues, only to find out during depositions that the physician spent less than ten minutes with the patient.
AMS RRG has continued to grow since it first insured physicians in May of 2003.Oneofourprimarygoalsatthattime was to help physicians reduce their risk of a lawsuit. This goal persists, and today we have multiple services to help our physicians reduce their risk of being sued and increase their chance of prevailing in any lawsuits
thatmaybefiled.Onourwebsite,youwillfindsomeoftheseservices,includingourlatest:DialogueMedical’siMedConsent™PEapplication, a web-based software that standardizes and automates the informed consent process.
We have reviewed very few lawsuits that specifically alleged a lack of informed consent. So why is so much attention paid to the informedconsentprocess?Firstandforemost,informedconsentmust be obtained prior to any invasive procedure or a physician couldbeaccusedofassaultandbattery(dependingonthenature oftheprocedure).Secondly,theinformedconsentprocess,whencompleted effectively, demonstrates the physician’s ability to communicate with their patients, and communication issues are at the heart of the majority of lawsuits. A physician who spends the time to make sure their patient understands the nature of the
New 2% Premium Credit Program
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offeredthroughLaw&Medicine,anACCME-accreditedorganizationwhichwasfoundedbyVictorCotton,MD,JD.Dr.CottoncreatedallofLaw&Medicine’seducationalmaterialsbasedonhisexperiencesof having practiced and taught both law and medicine. In addition tothepremiumcredit,physicianscanearnbothAMAPRACategoryICMECreditandAAFPPrescribedCreditforthecourses completed.
Visitwww.lawandmed.com/elearning/amsrrg/courses.php to view thecoursesandpricinginformation.Foranyquestionsaboutthepremiumcreditprogram,pleasecallJeffNelsonat866-461-1221 ext. 300.
AMS RRG members now receive a 30% discount off the standardcostofDialogueMedical’sinformedconsentproduct,which aids with the communication and documentation of all aspects of the shared decision-making process.
DialogueMedical’siMedConsent™PEapplicationisaweb-basedsoftware tool that standardizes and automates the informed consentprocess.Procedure-specificconsentformsareproducedfrom a comprehensive library of documents that detail the treatments being contemplated by individual patients. Accessible from all internet-connected computers within a practice, this resource also includes patient education documents, common forms for use in the practice, information sheets for prescription and over-the-counter medications, and an extensive image gallery.
Forcompletedetailsoftheoffer,visitourwebsiteat www.amsrrg.com and click on “Online Tools and Resources.”
Transfer of Risk continued from page five
Why execute indemnity agreements? A good argument exists that since a physician already has liability for his/her own acts of negligence; a contract is really not needed. Unfortunately, however, hospitalsnowfrequentlyaskphysicianstoexecuteindemnityagreements when they seek medical staff privileges or when they enter into professional services agreements. The physician faces the choice of entering into the indemnity agreement or possibly losing the contract or privileges at the hospital.
As a physician, the likelihood exists that you will be presented with anindemnityagreementinthefuture,ifyouhaven’talready.Protectyourself when faced with an indemnity agreement by remembering the following points:
•Havelocallegalcounselreviewanyindemnityagreementpriorto executing it.
•Uselimitedindemnitylanguage(notbroadlanguagewhereyouindemnifyeveryoneforanythingandeverything!).
•Requiremutualorreciprocalindemnificationlanguagefromthehospitalorwhoeverisrequestingtheindemnityagreement.
Indemnity agreements can be your shield or your sword!
Foranyquestions,yourclaims“team”isheretoassist.Calltollfreeat 866-520-6896.
4
StevenShapiro,MD
Informed Consent Discounts Through Dialogue Medical
“As part of your informed consent process,
describe the procedure, the anesthesia
associated with it, the key risks, available
alternatives as well as various options the
patient can choose from with the planned
procedure. In addition, a discussion
regarding long-term prognosis following the
procedure is appropriate as well.”
Dr.GaryWortz,whoworkswithiMedConsent(availablethroughtheAMSRRGwebsite)haspublishedsuggestionsforamoreeffective informed consent process:
• Donotexecutetheconsentformonthepatient’sfirstvisitwhile they are still learning about the procedure.
• Donotobtaininformedconsentonthedayoftheprocedure.(Thisiscommonplaceinthehospitalsetting,butjustbecauseithasalwaysbeendonethiswaydoesnotmakeitthebestway.)
• Obtainthepatient’sconsentintheofficesettingwhilethepatientiscomfortableandhastimetoaskquestions.
• Offerthepatientacopyoftheformtheyhavesigned.
• Educateyourpatientsthrough:
–Discussionswiththephysician
–Videosdepictingtheprocedure
– Comprehensive handouts
– A detailed, procedure-specific informed consent form
• Makesurethepatientisanactiveparticipantintheprocess,that they are paying attention and that they confirm their understanding of the procedure, its risks, benefits and alternatives.
• Ifthepatientisunwillingtoacknowledgetherisksyouhavedescribed, delay the procedure until they can demonstrate the appropriate understanding of those risks.
• Ifthepatientrefusestheprocedure,obtainarefusalof consentform,whichmeetsallofthesamerequirementsas the informed consent form.
• Makesurethereisnolanguagebarriertothepatienttrulyunderstanding the procedure. Get an appropriate translator if necessary who will document the informed consent process.
As part of the informed consent process, you will not be able to describe all of the potential risks to any procedure. It is important for patients to understand that there are risks to any procedure that, if they occur, cannot be fixed. Examples would include pulmonary embolism(despiteappropriateprophylaxis)followingakneereplacement, loss of vision following eye surgery, a hoarse voice after thyroid surgery and so on. The list is metaphorically endless.
2
As part of your informed consent process, describe the procedure, the anesthesia associated with it, the key risks, available alternatives as well as various options the patient can choose from with the planned procedure. In addition, a discussion regarding long-term prognosis following the procedure is appropriate as well.
Lastly,itisimportanttodocumentthepatient’spost-procedureresponsibilities. These include, but are not limited to, wound care, medication use and appropriate healthcare follow-up such as lab work(i.e.monitoringtheeffectofCoumadin),attendingrehabsessions, keeping follow-up physician appointments and so on.
While true negligence is still likely to result in a lawsuit, many cases may potentially be avoided involving risks that were well-documented and explained by the healthcare practitioner.
Ifyouhaveanyquestionsregardingyourinformedconsentprocess,pleasedonothesitatetocallStevenShapiro,MD,at800-367-1337.
3
Fall 2011 | Volume 010Insured Colleague
Informed Consent
ByStevenShapiro,MD,AMSRRGChiefMedicalOfficer
planned procedure is most likely one that communicates effectively in all aspects of their interaction with the patient, staff and other allied health personnel.
Many times, physicians believe that informed consent is obtained by nursing when the patient signs the consent form. While these forms oftenincludemanycaveatsregardingthequalityoftheinformedconsent process, these may not hold up in court unless there is documentationbythephysicianregardingthequalityoftheprocess.The patient, or the patient’s family, will simply say they were told to sign the form by the nurse in order to get the procedure, and that theyhadquestionsabouttheprocedurethatthenursingand/ormedicalstaffdidn’thavetimetodiscuss.Patientstrusttheirphysiciansand expect a problem-free outcome; many times, they will not take the informed consent process seriously unless the physician does.
In 2010,theJournaloftheAmericanCollegeofSurgeonspublishedanarticletitled“Predictorsofcomprehensionduringsurgicalinformedconsent,”whichstatedthatthetimespentwiththepatientduringthisprocess is one of the strongest predictors of patient comprehension of the true nature of the procedure including its risks, alternatives and benefits. It is noteworthy that many times you see a physician write down that they had an extensive discussion with the patient regarding various issues, only to find out during depositions that the physician spent less than ten minutes with the patient.
AMS RRG has continued to grow since it first insured physicians in May of 2003.Oneofourprimarygoalsatthattime was to help physicians reduce their risk of a lawsuit. This goal persists, and today we have multiple services to help our physicians reduce their risk of being sued and increase their chance of prevailing in any lawsuits
thatmaybefiled.Onourwebsite,youwillfindsomeoftheseservices,includingourlatest:DialogueMedical’siMedConsent™PEapplication, a web-based software that standardizes and automates the informed consent process.
We have reviewed very few lawsuits that specifically alleged a lack of informed consent. So why is so much attention paid to the informedconsentprocess?Firstandforemost,informedconsentmust be obtained prior to any invasive procedure or a physician couldbeaccusedofassaultandbattery(dependingonthenature oftheprocedure).Secondly,theinformedconsentprocess,whencompleted effectively, demonstrates the physician’s ability to communicate with their patients, and communication issues are at the heart of the majority of lawsuits. A physician who spends the time to make sure their patient understands the nature of the
New 2% Premium Credit Program
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offeredthroughLaw&Medicine,anACCME-accreditedorganizationwhichwasfoundedbyVictorCotton,MD,JD.Dr.CottoncreatedallofLaw&Medicine’seducationalmaterialsbasedonhisexperiencesof having practiced and taught both law and medicine. In addition tothepremiumcredit,physicianscanearnbothAMAPRACategoryICMECreditandAAFPPrescribedCreditforthecourses completed.
Visitwww.lawandmed.com/elearning/amsrrg/courses.php to view thecoursesandpricinginformation.Foranyquestionsaboutthepremiumcreditprogram,pleasecallJeffNelsonat866-461-1221 ext. 300.
AMS RRG members now receive a 30% discount off the standardcostofDialogueMedical’sinformedconsentproduct,which aids with the communication and documentation of all aspects of the shared decision-making process.
DialogueMedical’siMedConsent™PEapplicationisaweb-basedsoftware tool that standardizes and automates the informed consentprocess.Procedure-specificconsentformsareproducedfrom a comprehensive library of documents that detail the treatments being contemplated by individual patients. Accessible from all internet-connected computers within a practice, this resource also includes patient education documents, common forms for use in the practice, information sheets for prescription and over-the-counter medications, and an extensive image gallery.
Forcompletedetailsoftheoffer,visitourwebsiteat www.amsrrg.com and click on “Online Tools and Resources.”
Transfer of Risk continued from page five
Why execute indemnity agreements? A good argument exists that since a physician already has liability for his/her own acts of negligence; a contract is really not needed. Unfortunately, however, hospitalsnowfrequentlyaskphysicianstoexecuteindemnityagreements when they seek medical staff privileges or when they enter into professional services agreements. The physician faces the choice of entering into the indemnity agreement or possibly losing the contract or privileges at the hospital.
As a physician, the likelihood exists that you will be presented with anindemnityagreementinthefuture,ifyouhaven’talready.Protectyourself when faced with an indemnity agreement by remembering the following points:
•Havelocallegalcounselreviewanyindemnityagreementpriorto executing it.
•Uselimitedindemnitylanguage(notbroadlanguagewhereyouindemnifyeveryoneforanythingandeverything!).
•Requiremutualorreciprocalindemnificationlanguagefromthehospitalorwhoeverisrequestingtheindemnityagreement.
Indemnity agreements can be your shield or your sword!
Foranyquestions,yourclaims“team”isheretoassist.Calltollfreeat 866-520-6896.
4
StevenShapiro,MD
Informed Consent Discounts Through Dialogue Medical
“As part of your informed consent process,
describe the procedure, the anesthesia
associated with it, the key risks, available
alternatives as well as various options the
patient can choose from with the planned
procedure. In addition, a discussion
regarding long-term prognosis following the
procedure is appropriate as well.”
A Medical LiabilityInsurance Company
A P P L I E D M E D I C O - L E G A L S O LU T I O N S R I S K R E T E N T I O N G RO U P, I N C .
Insured Colleague
OverviewSince the last edition of Insured Colleague, the financial markets have experienced significant volatility due in part to the uncertainty surrounding Europe and, more specifically, Greece and Italy. There is no doubt we are in a global economy. And AMS RRG, like any other investor, is not immune to the market vagaries. But fortunately, we are
conservatively invested with no direct exposure to the foreign markets. I recently spent time with our investment manager, Brown Brothers Harriman & Co., and am extremely confident that our portfolio is in great hands. As evidence, we need look no further than our year-to-date performance with the corresponding growth in surplus from investments.
As for industry-specific trends, there have been several noteworthy consolidations in recent months:
•TheDoctorsCompanyacquiredFPIC
•NORCALacquiredMedicus
•MedProacquiredPrinceton(partofMLMIC)
As rates continue to stay low, many insurers are using merger and acquisitionstrategiestoimprovepremiumvolume.Additionally,manyinsurers, particularly ones in specific geographic areas, are concerned with the consolidation in the physician market. Hospitals are buying physician practices and placing them in the hospital’s medical liability insurance plan,whichmaybeacaptiveorothertypeproduct.Fortunately, AMS RRG, which is currently registered in 48statesandtheDistrict of Columbia, continues to grow and is not constrained by geographic limitations.
2011 Board Meeting HighlightsIn May, we hosted our annual Board and Shareholder Meetings in Scottsdale, Arizona. Highlights of the events included:
•TheminutesoftheMay6, 2010,andNovember23, 2010, meetingsoftheBoardofDirectorswereacceptedaspresented.
AMS RRG President’s Messageby Richard B. Welch
continued on page six
President’s Message continued from front page
5 6
AMS RRG, INC.
23Route31North
Suite A-10
Pennington,NJ08534
A Medical LiabilityInsurance Company
Richard B. Welch
In This Issue
• Informed Consent pg. 2
AMS RRG has continued to grow since it first insured physicians in May of 2003. One of our primary goals at that time was to help physicians reduce their risk of a lawsuit.
• New 2% Premium Credit Program pg. 4
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offered through Law & Medicine, an ACCME- accredited organization which was founded by Victor Cotton, MD, JD. Dr. Cotton created all of Law & Medicine’s educational materials based on his experiences of having practiced and taught both law and medicine.
• Informed Consent Discounts Through Dialogue Medical pg. 4
AMS RRG members now receive a 30% discount off the standard cost of Dialogue Medical’s informed consent product, which aids with the communication and documentation of all aspects of the shared decision- making process.
• Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements pg. 5
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms.
Fall 2011 | Volume 010 Fall 2011 | Volume 010
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms. Forinstance,alimitedformofindemnity agreement is narrow, shifting the loss to only those negligent acts caused solely by the indemnitor. At the other end of the
spectrum, a broad form of indemnity agreement shifts more loss to the indemnitor, even to the point of responsibility for acts of persons other than the indemnitor.
Consider the following:
An emergency medicine group has a professional services agreement (the“Agreement”)withitshospitalpartner,whichincludesamutual indemnification clause. Specifically, each party indemnifies and holds harmless the other party for its own independent acts of negligence. When an emergency physician misdiagnoses a patient, resulting in a bad outcome, a lawsuit usually names both the physician and the hospital. If the plaintiff makes no allegation of any independent acts of negligence against the hospital, but alleges only that the hospital is vicariously liable1 for the acts/omissions of theemergencyphysician,thehospitalmayrequestthattheEDgroup protect and defend the hospital based on the Agreement. Thehospitalmayarguethat“butfor”theacts/omissionsoftheEDphysician, the hospital would not be named in the lawsuit.
Each state has developed statutory and/or case law regarding vicarious liability and, specifically, vicarious exposure hospitals assume for their medical staff. Hospitals consistently try to push thedefenseofthesecasestothephysician(s)whoallegedlycommitacts/omissions of negligence. Many times, this push by the hospital isextreme.Forinstance,somehospitalswithclearindependentexposureinacase(eitherthroughnursingstafferrors,inadequate
policiesand/orsystemerrors)willnonethelesstrytorequirethephysicians to assume their defense. Most hospital risk managers acknowledge and understand that the hospital will always be consideredthe“deeppocket”byplaintiffattorneys.Bydesign,thehospital has higher professional liability limits. Given this, plaintiff attorneys always try to find some criticisms or independent or direct acts of negligence against the hospital and its employees, even if remote.
Hospitalsfrequentlyaskphysicianstoexecuteindemnityagreements.Unfortunately, professional liability carriers typically exclude this type of contractual indemnity from coverage. Therefore, an obligation to indemnify in the contract between the physician and/or group and the hospital does not pass on to the carrier under a professional liability policy. However, most carriers do cover a limited form of indemnification arising under common law. Given this, physicians must exercise caution when executing broad form indemnity agreements and/or contracts with indemnity clauses.
State statutes and common law dictate the presence of common law indemnity.Toprevailonacommonlawindemnityclaim,1)thepartyseekingindemnity(the“indemnitee”)mustbewithoutfaultand its liability must be solely vicarious for the wrongdoing of another;and2)thepartyagainstwhomindemnityissought(the“indemnitor”)mustbetheoneresponsibleforthetort.Intheseinstances,theindemniteemayrequesttheindemnitortoprotectanddefenditinthelawsuit.Typically,a“tender”letterfromtheindemnitee to the indemnitor indicating its intent to tender its defensesatisfiestherequirementstorequestindemnification.Theprofessional liability carrier may review the letter and, depending on state law and its policy, either accept or reject the tender. If accepted, assigned defense counsel for the indemnitor will protect and defend the indemnitee as well as the indemnitor. This is because, as a general rule, the insurance company wants to protect its insured against any cross action or claims for indemnification that may be filed at a later date.
As to agreements between a physician and hospital, the contractual indemnification language should be limited and mutual:
“Physicianagreestoprotect,defend,holdharmlessandindemnifyHospital for claims of professional negligence alleged against the Hospitalforthesoleacts/omissionsofthePhysician,includingattorneys’ fees and costs. Hospital agrees to protect, defend, hold harmlessandindemnifyPhysicianforclaimsofprofessionalnegligenceallegedagainstthePhysicianforthesoleacts/omissionsoftheHospital,includingattorneys’feesandcosts.”
Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements
bySusanMartin,Esq.,ExecutiveVicePresident,LitigationManagement/LossControl
•TonyHillandClareStensonwithBMS,ourreinsuranceintermediaries, reviewed our current reinsurance structure. They discussed the Corporation’s historical participation in the reinsurance markets, noting that some of the AMS RRG’s reinsurers have been working with us since inception. They alsopresentedafive-yearsummaryofLloyd’sofLondon’sperformance, which is stronger than ever.
•TheMedicalExecutive,UnderwritingandClaimsCommitteesmet over the two-day period. They discussed many ideas regarding continuous improvement to our risk and claims management and underwriting processes. I want to thank all ofourSpecialtyMedicalDirectorsandstaffwhoparticipatedin those meetings.
DividendForthethirdyearinarow,AMSRRGhasbeenauthorizedtoprovideadividend to its shareholders. Although it is a very difficult investment market, continued positive returns that have led to steady surplus growth coupled with ongoing profitability through strong underwriting and claims management have allowed us to issue the dividends.
2012
Asoftheendofthethirdquarter,grosswrittenpremiumwasjustover $26 million, on track toward our goal of $36 million for 2011. We see 2012 as another year of controlled growth while delivering value to our partners/insureds. We will continue to assess and provide the appropriate infrastructure needed to meet and exceed theneedsofourinsureds.Ourgoal,asalways,isunparalleledcustomer service so please let us know how we are doing.
Until next year, I wish you all a very happy and healthy holiday season!
•Saslow,Lufkin&BuggyLLPwereappointedasthe independent auditors of the Corporation for the year ending December31, 2011.
•AonRiskConsultants(GregoryLarcher,FCAS,MAAA)wereappointed as the independent actuary of the Corporation for theyearendingDecember31, 2011.
•TheauditedfinancialstatementspresentedtotheBoardbySaslow,Lufkin&BuggyLLPfortheyearendingDecember31, 2009, were accepted as presented.
•ThecurrentBusinessPlanoftheCorporationwasratified and approved as presented to the board.
•Weheardapresentationfromourinvestmentmanager,BillEnright,SeniorVicePresident,InstitutionalInvestmentManagement, at Brown Brothers Harriman & Co. He reviewed bothourfixedincomeandequitymarketportfolios,bothofwhich were outperforming the indices.continued on page four
Claims Committee meeting at Board Meeting in Arizona
SusanMartin,Esq.
“Hospitals frequently ask physicians to
execute indemnity agreements. Unfortunately,
professional liability carriers typically
exclude this type of contractual indemnity...”
1“Vicariousliability”istheimputationofliabilityupononepersonfortheactionsofanother.
Dr.GaryWortz,whoworkswithiMedConsent(availablethroughtheAMSRRGwebsite)haspublishedsuggestionsforamoreeffective informed consent process:
• Donotexecutetheconsentformonthepatient’sfirstvisitwhile they are still learning about the procedure.
• Donotobtaininformedconsentonthedayoftheprocedure.(Thisiscommonplaceinthehospitalsetting,butjustbecauseithasalwaysbeendonethiswaydoesnotmakeitthebestway.)
• Obtainthepatient’sconsentintheofficesettingwhilethepatientiscomfortableandhastimetoaskquestions.
• Offerthepatientacopyoftheformtheyhavesigned.
• Educateyourpatientsthrough:
–Discussionswiththephysician
–Videosdepictingtheprocedure
– Comprehensive handouts
– A detailed, procedure-specific informed consent form
• Makesurethepatientisanactiveparticipantintheprocess,that they are paying attention and that they confirm their understanding of the procedure, its risks, benefits and alternatives.
• Ifthepatientisunwillingtoacknowledgetherisksyouhavedescribed, delay the procedure until they can demonstrate the appropriate understanding of those risks.
• Ifthepatientrefusestheprocedure,obtainarefusalof consentform,whichmeetsallofthesamerequirementsas the informed consent form.
• Makesurethereisnolanguagebarriertothepatienttrulyunderstanding the procedure. Get an appropriate translator if necessary who will document the informed consent process.
As part of the informed consent process, you will not be able to describe all of the potential risks to any procedure. It is important for patients to understand that there are risks to any procedure that, if they occur, cannot be fixed. Examples would include pulmonary embolism(despiteappropriateprophylaxis)followingakneereplacement, loss of vision following eye surgery, a hoarse voice after thyroid surgery and so on. The list is metaphorically endless.
2
As part of your informed consent process, describe the procedure, the anesthesia associated with it, the key risks, available alternatives as well as various options the patient can choose from with the planned procedure. In addition, a discussion regarding long-term prognosis following the procedure is appropriate as well.
Lastly,itisimportanttodocumentthepatient’spost-procedureresponsibilities. These include, but are not limited to, wound care, medication use and appropriate healthcare follow-up such as lab work(i.e.monitoringtheeffectofCoumadin),attendingrehabsessions, keeping follow-up physician appointments and so on.
While true negligence is still likely to result in a lawsuit, many cases may potentially be avoided involving risks that were well-documented and explained by the healthcare practitioner.
Ifyouhaveanyquestionsregardingyourinformedconsentprocess,pleasedonothesitatetocallStevenShapiro,MD,at800-367-1337.
3
Fall 2011 | Volume 010Insured Colleague
Informed Consent
ByStevenShapiro,MD,AMSRRGChiefMedicalOfficer
planned procedure is most likely one that communicates effectively in all aspects of their interaction with the patient, staff and other allied health personnel.
Many times, physicians believe that informed consent is obtained by nursing when the patient signs the consent form. While these forms oftenincludemanycaveatsregardingthequalityoftheinformedconsent process, these may not hold up in court unless there is documentationbythephysicianregardingthequalityoftheprocess.The patient, or the patient’s family, will simply say they were told to sign the form by the nurse in order to get the procedure, and that theyhadquestionsabouttheprocedurethatthenursingand/ormedicalstaffdidn’thavetimetodiscuss.Patientstrusttheirphysiciansand expect a problem-free outcome; many times, they will not take the informed consent process seriously unless the physician does.
In 2010,theJournaloftheAmericanCollegeofSurgeonspublishedanarticletitled“Predictorsofcomprehensionduringsurgicalinformedconsent,”whichstatedthatthetimespentwiththepatientduringthisprocess is one of the strongest predictors of patient comprehension of the true nature of the procedure including its risks, alternatives and benefits. It is noteworthy that many times you see a physician write down that they had an extensive discussion with the patient regarding various issues, only to find out during depositions that the physician spent less than ten minutes with the patient.
AMS RRG has continued to grow since it first insured physicians in May of 2003.Oneofourprimarygoalsatthattime was to help physicians reduce their risk of a lawsuit. This goal persists, and today we have multiple services to help our physicians reduce their risk of being sued and increase their chance of prevailing in any lawsuits
thatmaybefiled.Onourwebsite,youwillfindsomeoftheseservices,includingourlatest:DialogueMedical’siMedConsent™PEapplication, a web-based software that standardizes and automates the informed consent process.
We have reviewed very few lawsuits that specifically alleged a lack of informed consent. So why is so much attention paid to the informedconsentprocess?Firstandforemost,informedconsentmust be obtained prior to any invasive procedure or a physician couldbeaccusedofassaultandbattery(dependingonthenature oftheprocedure).Secondly,theinformedconsentprocess,whencompleted effectively, demonstrates the physician’s ability to communicate with their patients, and communication issues are at the heart of the majority of lawsuits. A physician who spends the time to make sure their patient understands the nature of the
New 2% Premium Credit Program
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offeredthroughLaw&Medicine,anACCME-accreditedorganizationwhichwasfoundedbyVictorCotton,MD,JD.Dr.CottoncreatedallofLaw&Medicine’seducationalmaterialsbasedonhisexperiencesof having practiced and taught both law and medicine. In addition tothepremiumcredit,physicianscanearnbothAMAPRACategoryICMECreditandAAFPPrescribedCreditforthecourses completed.
Visitwww.lawandmed.com/elearning/amsrrg/courses.php to view thecoursesandpricinginformation.Foranyquestionsaboutthepremiumcreditprogram,pleasecallJeffNelsonat866-461-1221 ext. 300.
AMS RRG members now receive a 30% discount off the standardcostofDialogueMedical’sinformedconsentproduct,which aids with the communication and documentation of all aspects of the shared decision-making process.
DialogueMedical’siMedConsent™PEapplicationisaweb-basedsoftware tool that standardizes and automates the informed consentprocess.Procedure-specificconsentformsareproducedfrom a comprehensive library of documents that detail the treatments being contemplated by individual patients. Accessible from all internet-connected computers within a practice, this resource also includes patient education documents, common forms for use in the practice, information sheets for prescription and over-the-counter medications, and an extensive image gallery.
Forcompletedetailsoftheoffer,visitourwebsiteat www.amsrrg.com and click on “Online Tools and Resources.”
Transfer of Risk continued from page five
Why execute indemnity agreements? A good argument exists that since a physician already has liability for his/her own acts of negligence, a contract is really not needed. Unfortunately, however, hospitalsnowfrequentlyaskphysicianstoexecuteindemnityagreements when they seek medical staff privileges or when they enter into professional services agreements. The physician faces the choice of entering into the indemnity agreement or possibly losing the contract or privileges at the hospital.
As a physician, the likelihood exists that you will be presented with anindemnityagreementinthefuture,ifyouhaven’talready.Protectyourself when faced with an indemnity agreement by remembering the following points:
•Havelocallegalcounselreviewanyindemnityagreementpriorto executing it.
•Uselimitedindemnitylanguage(notbroadlanguagewhereyouindemnifyeveryoneforanythingandeverything!).
•Requiremutualorreciprocalindemnificationlanguagefromthehospitalorwhoeverisrequestingtheindemnityagreement.
Indemnity agreements can be your shield or your sword!
Foranyquestions,yourclaims“team”isheretoassist.Calltollfreeat 866-520-6896.
4
StevenShapiro,MD
Informed Consent Discounts Through Dialogue Medical
“As part of your informed consent process,
describe the procedure, the anesthesia
associated with it, the key risks, available
alternatives as well as various options the
patient can choose from with the planned
procedure. In addition, a discussion
regarding long-term prognosis following the
procedure is appropriate as well.”
A Medical LiabilityInsurance Company
A P P L I E D M E D I C O - L E G A L S O LU T I O N S R I S K R E T E N T I O N G RO U P, I N C .
Insured Colleague
OverviewSince the last edition of Insured Colleague, the financial markets have experienced significant volatility due in part to the uncertainty surrounding Europe and, more specifically, Greece and Italy. There is no doubt we are in a global economy. And AMS RRG, like any other investor, is not immune to the market vagaries. But fortunately, we are
conservatively invested with no direct exposure to the foreign markets. I recently spent time with our investment manager, Brown Brothers Harriman & Co., and am extremely confident that our portfolio is in great hands. As evidence, we need look no further than our year-to-date performance with the corresponding growth in surplus from investments.
As for industry-specific trends, there have been several noteworthy consolidations in recent months:
•TheDoctorsCompanyacquiredFPIC
•NORCALacquiredMedicus
•MedProacquiredPrinceton(partofMLMIC)
As rates continue to stay low, many insurers are using merger and acquisitionstrategiestoimprovepremiumvolume.Additionally,manyinsurers, particularly ones in specific geographic areas, are concerned with the consolidation in the physician market. Hospitals are buying physician practices and placing them in the hospital’s medical liability insurance plan,whichmaybeacaptiveorothertypeproduct.Fortunately, AMS RRG, which is currently registered in 48statesandtheDistrict of Columbia, continues to grow and is not constrained by geographic limitations.
2011 Board Meeting HighlightsIn May, we hosted our annual Board and Shareholder Meetings in Scottsdale, Arizona. Highlights of the events included:
•TheminutesoftheMay6, 2010,andNovember23, 2010, meetingsoftheBoardofDirectorswereacceptedaspresented.
AMS RRG President’s Messageby Richard B. Welch
continued on page six
President’s Message continued from front page
5 6
AMS RRG, INC.
23Route31North
Suite A-10
Pennington,NJ08534
A Medical LiabilityInsurance Company
Richard B. Welch
In This Issue
• Informed Consent pg. 2
AMS RRG has continued to grow since it first insured physicians in May of 2003. One of our primary goals at that time was to help physicians reduce their risk of a lawsuit.
• New 2% Premium Credit Program pg. 4
Through AMS RRG, insured physicians can now earn an immediate 2% premium credit by completing four hours of online education offered through Law & Medicine, an ACCME- accredited organization which was founded by Victor Cotton, MD, JD. Dr. Cotton created all of Law & Medicine’s educational materials based on his experiences of having practiced and taught both law and medicine.
• Informed Consent Discounts Through Dialogue Medical pg. 4
AMS RRG members now receive a 30% discount off the standard cost of Dialogue Medical’s informed consent product, which aids with the communication and documentation of all aspects of the shared decision- making process.
• Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements pg. 5
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms.
Fall 2011 | Volume 010 Fall 2011 | Volume 010
Risk transfer shifts risk from one party to another through contractual obligations or through common law. Indemnity agreements are contractual risk transfers, and take various forms. Forinstance,alimitedformofindemnity agreement is narrow, shifting the loss to only those negligent acts caused solely by the indemnitor. At the other end of the
spectrum, a broad form of indemnity agreement shifts more loss to the indemnitor, even to the point of responsibility for acts of persons other than the indemnitor.
Consider the following:
An emergency medicine group has a professional services agreement (the“Agreement”)withitshospitalpartner,whichincludesamutual indemnification clause. Specifically, each party indemnifies and holds harmless the other party for its own independent acts of negligence. When an emergency physician misdiagnoses a patient, resulting in a bad outcome, a lawsuit usually names both the physician and the hospital. If the plaintiff makes no allegation of any independent acts of negligence against the hospital, but alleges only that the hospital is vicariously liable1 for the acts/omissions of theemergencyphysician,thehospitalmayrequestthattheEDgroup protect and defend the hospital based on the Agreement. Thehospitalmayarguethat“butfor”theacts/omissionsoftheEDphysician, the hospital would not be named in the lawsuit.
Each state has developed statutory and/or case law regarding vicarious liability and, specifically, vicarious exposure hospitals assume for their medical staff. Hospitals consistently try to push thedefenseofthesecasestothephysician(s)whoallegedlycommitacts/omissions of negligence. Many times, this push by the hospital isextreme.Forinstance,somehospitalswithclearindependentexposureinacase(eitherthroughnursingstafferrors,inadequate
policiesand/orsystemerrors)willnonethelesstrytorequirethephysicians to assume their defense. Most hospital risk managers acknowledge and understand that the hospital will always be consideredthe“deeppocket”byplaintiffattorneys.Bydesign,thehospital has higher professional liability limits. Given this, plaintiff attorneys always try to find some criticisms or independent or direct acts of negligence against the hospital and its employees, even if remote.
Hospitalsfrequentlyaskphysicianstoexecuteindemnityagreements.Unfortunately, professional liability carriers typically exclude this type of contractual indemnity from coverage. Therefore, an obligation to indemnify in the contract between the physician and/or group and the hospital does not pass on to the carrier under a professional liability policy. However, most carriers do cover a limited form of indemnification arising under common law. Given this, physicians must exercise caution when executing broad form indemnity agreements and/or contracts with indemnity clauses.
State statutes and common law dictate the presence of common law indemnity.Toprevailonacommonlawindemnityclaim,1)thepartyseekingindemnity(the“indemnitee”)mustbewithoutfaultand its liability must be solely vicarious for the wrongdoing of another;and2)thepartyagainstwhomindemnityissought(the“indemnitor”)mustbetheoneresponsibleforthetort.Intheseinstances,theindemniteemayrequesttheindemnitortoprotectanddefenditinthelawsuit.Typically,a“tender”letterfromtheindemnitee to the indemnitor indicating its intent to tender its defensesatisfiestherequirementstorequestindemnification.Theprofessional liability carrier may review the letter and, depending on state law and its policy, either accept or reject the tender. If accepted, assigned defense counsel for the indemnitor will protect and defend the indemnitee as well as the indemnitor. This is because, as a general rule, the insurance company wants to protect its insured against any cross action or claims for indemnification that may be filed at a later date.
As to agreements between a physician and hospital, the contractual indemnification language should be limited and mutual:
“Physicianagreestoprotect,defend,holdharmlessandindemnifyHospital for claims of professional negligence alleged against the Hospitalforthesoleacts/omissionsofthePhysician,includingattorneys’ fees as costs. Hospital agrees to protect, defend, hold harmlessandindemnifyPhysicianforclaimsofprofessionalnegligenceallegedagainstthePhysicianforthesoleacts/omissionsoftheHospital,includingattorneys’feesandcosts.”
Transfer of Risk: Beware Overly Broad Contractual Indemnity Agreements
bySusanMartin,Esq.,ExecutiveVicePresident,LitigationManagement/LossControl
•TonyHillandClareStensonwithBMS,ourreinsuranceintermediaries, reviewed our current reinsurance structure. They discussed the Corporation’s historical participation in the reinsurance markets, noting that some of the AMS RRG’s reinsurers have been working with us since inception. They alsopresentedafive-yearsummaryofLloyd’sofLondon’sperformance, which is stronger than ever.
•TheMedicalExecutive,UnderwritingandClaimsCommitteesmet over the two-day period. They discussed many ideas regarding continuous improvement to our risk and claims management and underwriting processes. I want to thank all ofourSpecialtyMedicalDirectorsandstaffwhoparticipatedin those meetings.
DividendForthethirdyearinarow,AMSRRGhasbeenauthorizedtoprovideadividend to its shareholders. Although it is a very difficult investment market, continued positive returns that have led to steady surplus growth coupled with ongoing profitability through strong underwriting and claims management have allowed us to issue the dividends.
2012
Asoftheendofthethirdquarter,grosswrittenpremiumwasjustover $26 million, on track toward our goal of $36 million for 2011. We see 2012 as another year of controlled growth while delivering value to our partners/insureds. We will continue to assess and provide the appropriate infrastructure needed to meet and exceed theneedsofourinsureds.Ourgoal,asalways,isunparalleledcustomer service so please let us know how we are doing.
Until next year, I wish you all a very happy and healthy holiday season!
•Saslow,Lufkin&BuggyLLPwereappointedasthe independent auditors of the Corporation for the year ending December31, 2011.
•AonRiskConsultants(GregoryLarcher,FCAS,MAAA)wereappointed as the independent actuary of the Corporation for theyearendingDecember31, 2011.
•TheauditedfinancialstatementspresentedtotheBoardbySaslow,Lufkin&BuggyLLPfortheyearendingDecember31, 2009, were accepted as presented.
•ThecurrentBusinessPlanoftheCorporationwasratified and approved as presented to the board.
•Weheardapresentationfromourinvestmentmanager,BillEnright,SeniorVicePresident,InstitutionalInvestmentManagement, at Brown Brothers Harriman & Co. He reviewed bothourfixedincomeandequitymarketportfolios,bothofwhich were outperforming the indices.continued on page four
Claims Committee meeting at Board Meeting in Arizona
SusanMartin,Esq.
“Hospitals frequently ask physicians to
execute indemnity agreements. Unfortunately,
professional liability carriers typically
exclude this type of contractual indemnity...”
1“Vicariousliability”istheimputationofliabilityupononepersonfortheactionsofanother.
