History of health care risk management programs
Although a mature function in the insurance industry, Risk Management activities were inducted into the health care industry during the late 1970's as a response to the growing national malpractice insurance crisis. Back then, the function was essentially comprised of Quality Assurance nurses performing incident report review and trending in acute care hospitals, but with no loss prevention or control functions.
Due to the increase in frequency and severity of lawsuits in health care, hospital Risk Managers quickly broadened their knowledge and approach to loss prevention, spearheaded by the American Hospital Association's development of the American Society for Healthcare Risk Management (ASHRM). During the 1990's, there was significant growth in the number and location of Risk Management programs in health care, as Risk Management began to separate from QA and become a recognized entity in its own right. Professional health care Risk Managers could be found performing the functions of loss prevention, control and risk transfer in medical groups, ambulatory care facilities, and managed care companies by the end of that decade.
At the beginning of this current decade, a tightening of the insurance marketplace contributing to higher premiums, higher deductibles, and less available coverage for specific exposures began to affect all other health care providers; including senior housing and services. At the same time, the industry was experiencing their first exposure to a hungry plaintiff attorney market in concert with greater emphasis on quality outcomes, less contact with remotely located family members, and more unrealistic expectations of families and residents. These factors contributed to an increase in the frequency of lawsuits and severity of jury awards in an environment already riddled with regulations and scrutiny by oversight regulatory agencies.
Two relatively recent cases reflect the changing landscape of litigation in long term care. In the case of Norman v. Life Care Centers of America, Inc. (2003) 107 Cal. App.4th 1233, the appeals court determined that evidence of violation of Title 22 nursing home regulations may be introduced into the trial court as evidence of negligence per se, meaning negligence can be presumed based on that evidence. In the other precedent-setting case, Covenant Care v. Superior Court (2004) 32 Cal.4th 771, the appeals court determined that a plaintiff under the Elder Abuse and Dependent Adult Civil Protections Act (EADACPA) need not comply with provisions of Code of Civil Procedure, section 425.13 before making a punitive damage claim against a health care provider. This ruling undermined the protections of MICRA (the California Medical Injury Compensation Reform Act) in negligence claims against providers of care to the elderly and dependent adults. These cases, in concert with the increase in frequency and severity of claims in assisted living and skilled nursing facilities over the past 5 years, reflect the increasing complexity of delivering elder care and services, and the greater need in our sector for effective loss prevention and control.
CORE Risk Services, Inc has been established to meet this need by providing professional, experienced Risk Management assistance to long term care companies and facilities in the California not-for-profit, religious-based long term care marketplace.
For additional information, contact:
Kelley Woodfin RN, BS, DFASHRM, CPHRM President, CORE Risk Services, INC.
1914 East 9400 South #103
Sandy, Utah 84093
Office: (801) 930-5380
Fax: (818)484-2165
Cell: (310)749-0196